Alisa Trojansky: “It’s time to formalise the care sector and stop the privatisation trend”

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Alisa Trojansky, an assistant working for the Socialists and Democrats Group in the European Parliament, recently authored a new report, "Towards the Uberisation of Care?"


How to care for people in the context of the pandemic is a debate which increasingly interacts with profound long-term changes, most importantly an ageing population, raising questions about the sustainability of current care arrangements across Europe.


Across the continent, long-term care provision – which remains a highly gendered sector, with 90 per cent of care workers in the OECD being female – has been progressively privatised over recent years and decades, and is now marked by underfunding, low-pay, poor conditions and, in many countries, staff shortages.


As demand for care expands and the public sector fails to meet it, digital platforms are moving in to fill the gap, and redefine how home care is organised. Platform care does not get the same attention as the likes of Uber and Deliveroo do in the transport delivery sector, but it is an increasingly important part of the care sector, and one that has major implications for care workers.


Like digital platforms in other sectors, platform care uses a digital app to match clients to care workers, and usually provides a system for clients to rate workers. Care workers operate as independent contractors on the platform, with hours and rates of pay usually entirely determined in negotiation with the client. Care platforms have emerged across Europe in recent years. While there is no one dominant player which controls the European market yet, we may be just at the beginning of the Uberisation of care.


We spoke to Alisa Trojansky, an assistant in the Socialists and Democrats Group in the European Parliament and author of the recent report Towards the Uberisation of Care?: Platform work in the sector of long-term home care and its implications for workers’ rights, published by the Workers’ Group of the European Economic and Social Committee about the key findings of her report, and how the pandemic might affect the future of home care in Europe.


When we talk about digital platforms most people think about delivery workers for Uber or Deliveroo, not home care. Can you explain how platform care works, and in what ways it’s different and what ways it’s the same as other forms of gig work?


It’s really important to make the distinction, because it’s true that the attention on digital platforms is very much focused on specific transport services. Long-term care work, in general, is often [characterised by] very low paid jobs, usually done by women, disproportionately women from migrant backgrounds, and has typically been quite informal work, so the emergence of platform care needs to be understood in that specific context.


Another essential aspect is that care is not just a service, it is also a right, and in most European countries there is, to some extent, public provision for care. So this is very different from the delivery of food, for example. Also, most care workers are very vulnerable as well, and there is a special, closer relationship between the care worker and the client. It is not usually a one-off service; both sides gain from a long-term relationship.


So I think it is quite different from something like Uber, because the carer and the client aren’t simply put together by an algorithm. The platform acts as an intermediary, but it’s usually a mechanism by which care worker and client connect with each other locally, consider whether the client’s needs can be met by the care worker, and the pay rate the client can offer, and then decide whether to proceed. I think a pure Uber model would be quite a horrific scenario because there has to be choice involved for both parties.


I saw some home care apps that were really Uber-like, but they were mostly in the United States. There is no real stand-out company in Europe that does it that way yet. It is quite fragmented at the moment because it’s at an early stage of development: different European countries have different types of platform care, while in some countries platforms have not really developed yet. Usually it is dependent on the extent of formalised care which is on offer from the public sector.


Your report finds home care has been increasingly privatised and deregulated across Europe in recent decades. You also identify cases of government outsourcing to platform care providers. Has platform care emerged out of care privatisation in Europe?


There is a huge growing market for home care, and it is partly because of the individual or the family is forced to address the issue themselves because services are just not available or the funding that governments’ provide for care is not sufficient. I think that privatisation does lead to people looking for alternative solutions.


In terms of outsourcing, there are examples of platform care providers starting to get paid directly from the government for care provision, or indirectly via the individuals getting reimbursed by the government. The extent to which outsourcing to platform care providers is accepted by governments will, I think, be an important factor in how much platform care grows going forward.


Platform care obviously has major implications for care workers, most obviously because they are exposed to the power of client ratings, which can then affect what future work they can get. There are also questions about occupational safety and training, and what (if any) responsibility platforms take for that. How does platform care affect workers’ rights?


The platforms promote themselves to workers by saying they can achieve much higher wages than in the formalised care sector, but I think this misses out the other aspects which are really not covered and would be covered if the service was provided by an employer. For example, health and safety aspects and insurance issues, which are really important for services provided in the home.


And then there are no real possibilities to build trade unions and negotiate with the platform as an employer. This makes it really hard for workers to organise themselves, and I think in terms of regulations this an issue which needs to be addressed – home care workers need to have the right to negotiate, and just to get to know each other, because a single worker on the platform may always feel alone, because they don’t necessarily come into contact with any other workers.


That was one of the key recommendations in my report – that platforms must provide a means by which workers can connect with one another. And also a conflict resolution process, so that if there is a conflict between the client and the worker, it doesn’t automatically end up in a bad rating for the worker, because that’s a market mechanism that is quite unfair to the worker.


At the moment on most care platforms the number of clients is much higher than the number of workers, so workers are maybe in a stronger position to choose their work than if they were an Uber driver, for example. But the ratings system is decisive in the end, because it’s very difficult for a person outside the home to judge if the rating is fair or not.


One of the platforms you case studied, Home Care Direct in Ireland, take 13 per cent commission on every transaction. Why do clients and care workers not simply bypass the platform once they have established contact with one another? Is that not a threat to the platform care business model?


Many platforms have in their terms and regulations that users are not allowed to circumvent the platform. But I think it is interesting because the reasoning given for this is ‘we provide you with the security and we are there for you if something goes wrong’. But then in practise it is questionable whether the platform do any of that, because platforms do not actively take care of health and safety issues and insurance issues. I think it is definitely possible [for the platform to be bypassed], but apparently the model works because otherwise these platforms wouldn’t exist.


The pandemic has obviously had a huge impact on the care sector. Many home care workers lost their jobs almost overnight as the home was locked down. What do you see as the short-term and long-term fall-out of the pandemic on platform care?


The pandemic has revealed the vulnerability of the workers, because they are in other people’s home, with few protections offered by governments to workers in this situation. Home care workers were largely excluded from government support. The economic impact was obviously huge as well. But in another sense, the pandemic has revealed the importance of migrant workers to home care in Europe, and has shown that it is a really Europeanised labour market. People move from their home country to provide home care services and of course many people moved back to their home country when they or their family were seriously struggling in the pandemic, or had lost work. So there has been a new attention brought to the conditions of these workers.


In terms of whether the pandemic will really change the trends we have seen in care before the crisis, I’m not so sure. We still have a huge shortage of care workers around Europe, and the time for family members to meet care obligations themselves is increasingly scarce. So I think what we will see in the future is an extended care sector, as there will be a growing demand for these services.


Your report makes recommendations at both the national level and EU level for legislative changes. How should governments tackle the rise of platform care?


One of the main issues to address is just to formalise the whole sector, and to stop the privatisation trend. Because I think privatisation is often driven by cost pressure, so I think it’s a question of public investment as well.


The sector needs to be regulated, there needs to be skills development and qualifications to prevent the de-professionalisation of care, and I think in the long-term we should think about whether platforms should be publicly run, whether the technology used by these platforms has to be controlled privately.


So I think it’s a question of good working conditions and fair pay, to have the services provided with good quality, with training. This is not just an issue of workers’ rights but also for the dignity of elderly people.


This is an edited version of an article that was first published on Brave New Europe.


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